A 65-year-old man was transferred from the Department of
Vascular Surgery to
Nephrology because of
cardiac arrest during
hemodialysis. He underwent incision and
drainage for
treatment of a
buttock abscess. Nafamostat
mesilate was used as an
anticoagulant for
hemodialysis to
address bleeding from the incision and
drainage site.
Sudden cardiac arrest occurred after 15 minutes of
dialysis. The
patient was treated in the
intensive care unit for 5 days.
Continuous veno-venous hemodiafiltration was started without any
anticoagulant in the
intensive care unit. Conventional
hemodialysis was reinitiated, and nafamostat
mesilate was used again because of a small amount of continued
bleeding. Ten minutes after
hemodialysis, the
patient complained of anaphylactic
signs and symptoms such as
dyspnea,
hypotension, and facial swelling.
Epinephrine,
dexamethasone, and pheniramin were injected under the suspicion of
anaphylactic shock, and the
patient recovered. Total
immunoglobulin E titer was high, and
skin prick test revealed weak positivity for nafamostat
mesilate. We first
report a case of
anaphylactic shock caused by nafamostat
mesilate in
Korea.